Behind the eyelashes is a row of approximately 25 glands in a row on both the upper and lower eyelid margins. These Meibomian glands secrete an oily substance that is smeared over the watery tear film covering the eyeball every time you blink. The secretion of these glands can unfortunately get obstructed and also get infected, leading to blepharitis as well as stye formation.
Blepharitis causes a red inflamed eyelid margin with matiness in the mornings and collection of fatty collarettes around the eyelashes. This leads to grittiness and irritation, caused by a secondary infection by staphylococcal organism usually present on the eyelids. Blepharitis is often a recurrent problem, despite the optimal treatment, and the mainstay of control is lid hygiene.
Due to the fact that the accumulations on the eyelid margin consist of a fatty substance, water alone is not sufficient in cleaning the eyelids. The collarettes can be softened with a warm compress and removed using a soapy solution. Baby shampoo can be diluted at a rate of four to one with luke warm water and an earbud dipped in the solution and used to clean the eyelid margin. It is very important to clean the eyelid margin just behind the row of eyelashes. There is also commercially available cleaning solutions like Navi-Blef that is a foam; it is applied to the eyelids and then washed away after cleaning.
As mentioned lid hygiene is the cornerstone of treatment, and early application will resolve most of the symptoms associated with blepharitis, but it is often necessary to treat the concomitant Staphylococcal infection. Topical Fucithalmic ointment is used for this. It is applied to the eyelid margin after cleaning.
The warm compress softens the collarettes, the soapy solutions cleans the fatty accumulations and the topical antibiotics kills the organism responsible for the secondary infection. It is further important to note that a blepharitis is divided into an anterior (affecting the eyelashes) and posterior (affecting the Meibomian glands) blepharitis. With a posterior blepharitis it is also necessary to use an oral antibiotic. Some antibiotics have an apolipoprotein action that promotes the secretion of the Meibomian glands, preventing obstruction and inflammation.
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